Healthcare Provider Details

I. General information

NPI: 1043217615
Provider Name (Legal Business Name): LONG BEACH SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVENUE SUITE 160
LONG BEACH CA
90806-1715
US

IV. Provider business mailing address

20 BURTON HILLS BLVD. SUITE 500 ATTN: L&C
NASHVILLE TN
32715-6176
US

V. Phone/Fax

Practice location:
  • Phone: 562-988-9566
  • Fax: 562-997-4597
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283